Video: Dirty dining investigation

Love it or hate it, fast food is a part of our lives. Tens of millions of fast food meals are served safely every day. But with 200,000 fast food restaurants, keeping them clean and the food safe can be an enormous task -- and, on occasion, mistakes can be made and customers do get sick.

In a groundbreaking report in late 2003, Dateline ranked the top ten fast food chains, and revealed which ones ran up the highest number of critical health code violations. Critical violations are the ones that can make you sick.

Back then, we looked closely at thousands of health inspection reports, and discovered some dirty dining -- a worm in a salad, a cockroach in a soda, chewing gum in a taco. Horror stories like these are rare, but about two thirds of the restaurants we reported had at least one critical health code violation in the previous year.

Mary Adolf: “Any time there's a critical violation in a food service operation, it's of concern to us at the National Restaurant Association, but also of concern to the industry, because food safety is paramount. “

Mary Adolf is a vice president of the National Restaurant Association. She says the fast food chains are working to eliminate critical violations.

Adolf: “Food safety is non-negotiable to every single operator in the food service universe.”

After our original Dirty Dining survey, the big fast food chains promised to do better. Well, are they doing better?

The only way to find out was to "super-size" our first fast food survey. So we gathered and analyzed a year's worth of inspection reports 1,000 fast food restaurants from all across the country. Based on our new survey, we’ll give you the fresh rankings of the ten biggest fast food chains. We'll tell you which operations are doing the best and the worst job of keeping things safe and clean.

If you eat fast food, you'll want to know what we found. While it is not common for people to get sick, some of the people we spoke with discovered that when fast food restaurants make food-handling mistakes, it can be devastating.

Patrick Johnson and about 120 other customers became very sick, very quickly, last October after eating at McDonald's in Piqua, Ohio.

Johnson: “They put me on a stretcher. And the whole time I'm puking off both sides of the stretcher all the way through the house.”

Nancy Smith thought she was having a heart attack.

Smith: “But I had never been so sick in my life. It was so violent that I just felt like my chest was going to explode.”

Courtney Ward says she was paralyzed with pain.

Ward: “I had horrible, horrible stomach cramps. It just felt literally like someone just ripped my stomach open and was tearing through my stomach with nails. It hurt that bad.”

That night, this group and many more victims overwhelmed the emergency room at Ohio's Upper Valley Medical Center.

Smith: “They had like 30 people sitting around, were holding pans and throwing up. It was chaos.”

Dr. Curtis Caughey: “Quite frankly, it really stretched us to the limit of our resources.”

Dr. Curtis Caughey was in charge. He says initially, doctors had no idea what kind of outbreak they were facing.

Dr. Caughey: “The thing you think about when the squad alarms are going off, and the ambulances are rushing in. The people are sick out in the waiting room. You know, are we dealing with a really catastrophic public health incident that requires, you know, mobilizing major resources, particularly a bioterrorism incident.”

But it wasn't bioterrorism. It was a malfunctioning ice cream machine at McDonald’s. A Health Department investigation found the ice cream had not been kept at the proper temperature and was contaminated with dangerous bacteria.

Dr. Caughey: “The Health Department went to the restaurant, obtained samples from the machine. Indeed, identified a staphylococcal entro toxin that indeed caused the illness.”

McDonald's declined an on-camera interview, but in a letter to Dateline says the Piqua incident was "an unfortunate, isolated case." and said the ice cream machine was replaced immediately. The chain also maintains out that restaurant has "an outstanding food safety and sanitation history with the local health department."

Finding out which restaurants are clean, and which are not, is the job of local health inspectors like Yvonne Martinez of Nashville, Tenn. They are the public's first line of defense when it comes to restaurant safety. Martinez says restaurant inspectors watch for critical violations.

She says those critical violations are more often linked to food born illnesses. However, a critical violation doesn't necessarily mean someone will get sick. The top priority on her list is checking food holding temperatures.

Martinez: “Anything above 140 degrees is what I'm looking for.”

She wants to make sure hot food is kept hot and cold food kept cold.

Inspector Martinez peeks under the counters and scrutinizes the bathrooms.

The next stop for inspector Martinez is a Nashville Wendy's. The manager would not allow Dateline's camera in, so we waited outside. So how did this Wendy's do? Martinez found two critical violations: improper toxic chemical storage and a broken hose in the sink.

Martinez: “Unfortunately, we do tend to find at least one critical violation in most establishments.”

Next up is Taco Bell. Inspector Martinez weaves through the kitchen with her thermometer poised for action. She makes sure a refrigeration unit is at the right temperature. Holding temps at Taco Bell, she says, are especially important. She says the Taco Bells on her beat usually do very well. She thinks they do a good job training their employees. And this inspection goes well, with no critical violations.

And so it goes. All over the country, every day. hundreds of inspectors like Yvonne Martinez file reports on restaurant operations. For our new survey, Dateline analyzed thousands of those reports on the top ten fast food restaurants in the country. We took our hidden cameras along as we looked behind the counters and into the kitchens of the fast food giants. And we bought a lot of burgers, fries and tacos.

Dateline took our hidden cameras along when we ate at the nation's largest fast food chains. We found many clean, efficient restaurants. But we also found some dirty, unsanitary scenes. When it comes to fast food horror stories, restaurant inspectors hear it all -- like the story fast food customer Pete Stemen tells. He ate a hair pin -- and he has the pictures to prove it. But where did it come from?

Stemen: “I went to a fast food restaurant, had a breakfast sandwich meal. About 10, 15 minutes later, I started getting really bad heartburn or pain.”

A health inspector investigated. But there was no way to prove whether or not Stemen had swallowed the hair pin at the fast food place, or somewhere else. But you can't convince Pete Stemen the fast food chain is not at fault.

Stemen: “The fast food worker had her hair up in pins.“

Individual incidents like Stemen's are often difficult to prove. We've seen a lot of complaints in the inspection reports that could not be proven, or disproved -- a roach in a salad, a hair in a milkshake. But inspectors were able to verify these cases:

At a Wendy's in Waukegan, Ill., a customer complained she found glass in her chili. It turned out to be a broken piece of plastic.

At a Hardee's in Midlothian, Va., workers served raw, undercooked chicken tenders to children, and some of them got sick. At another Hardees, an employee was eating and then licking their fingers while filling an order.

The horror stories are stomach turning, but rare. To get the big picture, Dateline hired a sampling company to randomly choose 1000 fast food restaurants -- 100 each from the biggest chains. We asked for a sample from all over the country.

Then we collected a year's worth of city and county health reports for each restaurant, 2,400 inspections in all. It took six weeks to gather all the reports -- and another month to analyze them for critical violations. When questions came up, we called the local health inspector to get the answer. We learned inspection standards vary across the country, but every jurisdiction counts critical violations, the ones that can make you sick. From restaurant owners to food inspectors, everyone agrees, one critical violation is one too many, so that's all we counted for our survey.

Dateline compiled those thousands of health reports to tell you which chain in our survey does the best job keeping its restaurants clean. Since inspectors show up unannounced several times a year, depending on local procedures, we calculated the average number of critical violations per inspection, as a way to compare the chains. From the restaurant chain that kept things cleanest to the chain with the poorest performance in our survey, here are Dateline's Dirty Dining rankings.

1. Jack in the Box: For every 100 routine health inspections, Jack in the Box averaged 45 critical violations. That's less than one critical violation for every two inspections. The chain's performance was strong enough to make it one of the two restaurants that stood above the rest in our survey. the other?

2. Taco Bell: For every 100 inspections, the chain averaged 62 critical violations. Indeed, Taco Bell does things differently than most of the other chains. Its meat products are prepared at off-site, commercial kitchens, and not at the actual restaurant. The workers at a Taco Bell just heat and serve.

3. Wendy’s: Wendy's averaged 84 critical violations and is the most improved chain compared to last year's survey. It's most common problem was improper holding temperatures. It's the same violation we saw most often in all of the surveyed restaurants.

Statistically, Wendy's, Taco Bell and Jack in the Box turned in performances that separated them from the rest of the fast food pack. The seven other chains did not perform as well in our survey and are bunched pretty closely together.

4. SUBWAY: The 'think fresh' sandwich chain averaged 98 critical violations per 100 inspections. SUBWAYs serve a variety of cold-cut sandwiches, so keeping meat at the proper holding temperature is key. But improper temperature holding was the most frequently cited violation at the SUBWAYs in our survey.

4. (Tie) Dairy Queen: DQ also averaged 98 critical violations for every 100 inspections. At a DQ in Virginia, we saw a worker touching and then cooking meat, then switch to preparing ice cream without washing her hands. That's potential cross contamination of food. In fact, our survey revealed the highest percentage of violations at DQ were cross contamination.

Half way through our list now, and the first five restaurants all averaged fewer than one critical violation per inspection. But as we move through the bottom half of our list, the average critical violations are rising.

6. KFC: The colonel's crew rang up an average of 102 critical violations. A recurring problem was cross contamination. KFC has to be careful so raw chicken does not contaminate other food items. And there were other violations as well. A KFC in Chandler, Ariz. had eight critical in just one inspection last March. It was cited for a buildup of grime and mold on the soda nozzles and that, inspectors say, can cause bacterial growth. They were also cited for selling out of date chicken pot pies.

7. Burger King: The flame-broiled burger chain averaged 111 critical violations per 100 inspections, more than one per inspection. The Burger Kings in our survey ran up high numbers of improper holding temps and cross contamination violations. At one Burger King we saw an employee drying his wet hands on his shirt, then waiting on a customer. There was a puddle on the floor and soda nozzles caked with syrup.

8. Arby’s: For every 100 inspections, Arby's averaged 115 critical violations. The roast beef sandwich is Arby's signature item, but our survey indicates that too often, the roast beef is left sitting out too long. More than half the Arby's we surveyed had holding temp violations, and that can be dangerous.

9. Hardee’s: The chain averaged 118 critical violations per 100 inspections. It had one of the highest number of critical violations in Dateline's original survey as well. This year, Hardee’s racked up the highest number of violations for mold and grime of all the chains. One location in Virginia had seven criticals in one inspection alone, including grime and debris stuck to the soda nozzles.

10. McDonald’s: The chain averaged 126 critical violations for every 100 inspections, the highest average in our survey. McDonald's was the only chain where hand washing was the most commonly cited violation. Either inspectors witnessed employees not washing their hands or the restaurants had inadequate handwashing facilities.

So there's our 2005 fast food Dirty Dining list. Jack in the Box and Taco Bell had the fewest average violations in our survey, Hardee’s and McDonald's the highest violation rate. The good news? Seven of the 10 chains did a little better than they did in last, averaging fewer critical violations per inspection. But keep in mind, just like last year, about two thirds of the restaurants we surveyed had at least one critical violation.

We took the results of our survey to Mary Adolf of the National Restaurant Association.

Adolf: “All of the 10 chains that were involved in your survey certainly have very sophisticated quality assurance and training programs, and I sincerely believe that they're working very diligently to make sure that those programs are implemented every single day. The training never stops.”

Again, food borne illness is rare, but remember all these people in Ohio? They are still angry they became so violently ill, just because they ate at a fast food restaurant. Most of them say they won't trust fast food again.

Lea Thompson: “Can people walk into a fast food restaurant today and assume that they won't get sick?”

Adolf: “To put it in context, the fact that we serve 61 million meals every single day in quick service restaurants in over 200,000 stores, I think that record speaks for itself.”

Dateline wires the home of a volunteer, Jenny, from top to bottom with hidden cameras. Then she called repairmen to her house for a simple problem we created as a test with Jenny's pool. NBC's Chris Hansen reports.